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Knowing whether you can choose your own hospital or doctor under California workers’ compensation laws is more complex than it may seem. The short answer is yes. However, there are many regulations. If you want to ensure you can see your own doctor, it is imperative to predesignate your care provider.
If you have concerns about caring for a workplace injury and ensuring your bills are covered, a Los Angeles workers’ compensation lawyer may be helpful. KJT Law Group provides free initial consultations. Call (818) 507-8525 to learn more.
How Do I Know Where to Go to the Hospital After a Workplace Accident?
If you have a serious injury, you should not hesitate to go to the nearest emergency department for assessment and treatment. If you designated a facility or your company has a preferred location, it is likely nearby and a good choice for getting care quickly. If you receive ambulance transportation, the paramedics will likely make this choice for you.
When injuries are less serious, this becomes more complicated. You want to ensure the workers’ comp insurer will pay for your care, so you want to follow all applicable rules. According to the California Department of Industrial Relations (DIR), the doctor you will see initially depends on how your company structures its workers’ compensation benefits.
Generally, the insurance company will name the doctor you will see for the first 30 days following your injury. However, if your company has certain setups, your options might be different.
Working With an MPN
Some insurers have a medical provider network (MPN) pre-selected to care for injured workers. This includes a team of physicians, specialists, and other health care providers. The Division of Workers’ Compensation (DWC) approves all MPNs. Your employer should have a list of all doctors in the MPN near you. You can see any doctor within the MPN.
When an HCO Manages Care
Some workers must see doctors within a certified health care organization (HCO). The DWC certifies HCOs to ensure the doctors and other care providers understand workers’ compensation, common workplace injuries, and other necessary details in these cases. The HCO will oversee your treatment and care.
Predesignate Your Doctor If You Want to Ensure You Get a Choice
Many workers have the right to predesignate a personal physician, medical practice, or hospital to provide their care. This is the best way to ensure you can see your doctor from the start following a work-related injury or illness.
Each year, usually during your annual benefits meeting, you will need to submit your designation in writing. It notifies your employer and the insurance carrier of your preference to see your own health care providers. You cannot complete this paperwork later. You must predesignate the doctor.
There are some limits to this, though. For example, the insurance company may not allow you to predesignate a doctor outside the covered network.
When Can I See Another Doctor After a Workplace Injury in Los Angeles?
According to California labor laws, when you can choose another doctor depends on the setup of the workers’ compensation policy.
Switching Doctors Without an MPN or HCO
If you do not have an MPN or HCO, you can switch doctors once in the first 30 days, but the insurer chooses the new doctor. You can choose your own doctor after 30 days. You can even swap doctors more than once if needed after this time passes.
Choosing a Doctor Outside of the MPN
If you see a doctor within an MPN, you can change doctors within the network twice. If you want to go out of network, you will need to request an independent medical review of your current doctor to show why you need to change again.
Moving Outside of an HCO
If your employer has an HCO contract, you can likely only swap within the HCO once. The party overseeing your claim will choose the new doctor, not you. To get a doctor outside of the HCO, you have a waiting period of 90 days if you have insurance from your employer or 180 days if you have insurance through another source.
Understanding How Workers’ Compensation Works in California
California law requires almost all businesses in California with employees to provide workers’ compensation insurance coverage for their workers. When a worker suffers an on-the-job injury, the workers’ comp policy should provide a number of benefits to help them heal and make ends meet until they do. This could include:
- Medical treatment, treatment, prescription medications
- Indemnity benefits, which cover a portion of the worker’s usual wages
- Supplemental job displacement benefits, such as vouchers for education and training
- Death benefits for surviving family members
When a worker suffers injuries at work or in a work-related incident, they can go to the nearest emergency department or see the designated doctor for care. Workers’ compensation should cover their medical care from the initial visit.
What Does a Workers’ Compensation Attorney Do?
There are some situations when the workers’ compensation claims process does not go smoothly. The insurance company or employer is causing a problem, and the injured worker cannot get the benefits they deserve. This compensation could include medical care coverage or wage loss benefits.
Workers’ compensation attorneys represent injured workers, helping them fight for the compensation they deserve and ensuring their right to benefits remains protected. They also offer advice about changing doctors and related concerns. Hiring an attorney means having someone with knowledge and experience in these cases by your side every step of the way.
Discuss Your Workplace Injury With Our Team for Free
Our team at KJT Law Group provides free case evaluations for injured workers in Los Angeles. We can assess your options with you and see if you can choose your hospital under workers’ compensation laws. Contact or call us at (818) 507-8525 to connect with our team today.
